ABSTRACT
Objective:To investigate the association between metabolically healthy obesity(MHO) and atherosclerosis risk among Chinese community population aged 40 or older.Methods:A total of 9 525 participants without cardiovascular diseases (3 621 men and 5 904 women) from Jiading community in Shanghai were enrolled to complete questionnaires, undergo extensive physical examination including brachial-ankle pulse wave velocity (baPWV) and blood pressure (BP) assessment, and laboratory screening. According to body mass index (BMI) and metabolic status, these participants were categorized into 4 groups including metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), MHO, and metabolically unhealthy obese (MUO). High baPWV was defined as baPWV>1 400 mm/s, and high pulse pressure (PP) was defined as PP above fourth quartile of the population. Multivariate logistic regression model was conducted to explore the relationship between MHO and high baPWV as well as high PP after adjusting for confounders. Results:After multivariable adjustment, such as sex, age, current smoking, current drinking, and education, logistic regression analysis showed that MHO was significantly correlated with high baPWV ( OR=1.18, 95% CI 1.02-1.37) and high PP ( OR=1.72, 95% CI 1.43-2.08) in comparison with MHNO. Otherwise, both MUNO and MUO subjects were at higher risk for suffering from high baPWV (MUNO: OR=3.02, 95% CI 2.60-3.50; MUO: OR=3.26, 95% CI 2.87-3.70) and high PP (MUNO: OR=2.56, 95% CI 2.17-3.02; MUO: OR=3.49, 95% CI 3.01-4.06). Conclusion:On the basis of Chinese community population, there was a pronounced correlation between the MHO phenotype and the increased risk of developing atherosclerosis.
ABSTRACT
The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown. This study aimed to investigate this association in a community-dwelling population aged ≥ 40 years in Shanghai, China. Oral glucose tole3rance test was conducted during baseline and follow-up visits. Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk. A total of 613 (10.3%) incident diabetes cases were identified during the follow-up visit after 4.5 years. Fasting plasma glucose, postload glucose, and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid (all Ps < 0.05). The incidence rate of diabetes increased across the quartiles of serum uric acid (7.43%, 8.77%, 11.47%, and 13.43%). Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid (odds ratio (95% confidence interval) = 1.36 (1.06-1.73)). Stratified analysis indicated that the association was only observed in women. Accordingly, serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , China/epidemiology , Diabetes Mellitus/epidemiology , Incidence , Prospective Studies , Risk Factors , Uric AcidABSTRACT
Objective:To investigate the correlation between exposure to famine in early life and later risk of type 2 diabetes in adulthood.Methods:A cluster sampling method was used to include 8 868 residents who were lived in the Jiading community of Shanghai during the Great Famine from 1959 to 1962 in China. Subjects were divided into non-exposed group, fetal exposure group, childhood exposure group, and adolescent exposure group. Logistic regression model was used to analyze the relationship between famine exposure in early life and the risk of type 2 diabetes in adulthood. Results:Famine exposure during childhood and adolescent both increased the risk of developing type 2 diabetes in adulthood in women. No significant correlation was observed in men. In subjects with less physical activity and lower education level, the risk of developing type 2 diabetes mellitus in adulthood was significantly higher in the famine-exposed group than that of non-exposed groupand the interactions were statistically significant.Conclusion:Early life famine exposure increases the risk of developing type 2 diabetes in adults, especially in women.
ABSTRACT
Objective@#To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps.@*Methods@#From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed.@*Results@#A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar.@*Conclusions@#Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.
ABSTRACT
Children are a special group, which have unique physiological characteristics and are still in the period of physical and mental growth and development, thus the prevention and treatment of scar in children are different from that in adults. Scar management in children is a complex and multifaceted system engineering. The grade of scar in children needs to be adjusted according to the age, period, and severity. Corresponding method needs to be chosen for the treatment of scar in children according to the classification of the scar. The compliance of children is poor, and the key to scar treatment is the persistence and cooperation of the parents, so doctors should strengthen propaganda and education to the parents of children with scar. For children with scar, individualized and comprehensive treatment should be used according to the characteristics of children to achieve good results.
ABSTRACT
Objective@#To explore the methods and the long-term outcome of composite skin graft with mesh acellular allogeneic dermal matrix(allo-ADM)and split thickness autogenous skin giant congenital melanocytic nevi in infants.@*Methods@#From January 2012 to February 2017 our department applied acellular allogeneic dermis matrix(allo-ADM)with split thickness autogenous skin to treat 55 Giant congenital melanocytic nevi in infants and children aged 3 months to 5 years and 10 months, an average age was 1 years and 2 months, the area of 1%-25% TBSA. There were 12 cases of head and face, 28 cases of trunk and 15 cases of limbs. In operation, giant congenital melanocytic nevi was totally or partially resected, and using allo-ADM and split thickness autogenous skin graft to cover the wounds. Pressured gauze was removed 2 weeks after surgery, and at the same time the cicatricial rehabilitation was performed. The follow-up point was at 3 months, 6 months, 1 year, 2 years, to observe composite skin′ color, softness, and pathological examination of giant nevus and composite skin after 1 years were performed.@*Results@#2 weeks after transplantation the composite skin survival rate in 70%-100%; 38 cases were followed up for more than 2 years. For patients, over 1 years postoperatively, the composite skin presented soft and flexible, and the color were closed to the normal skin.@*Conclusions@#Acellular allogeneic dermis matrix with split-thickness autogenous skin to composite transplantation can effectively improve the appearance and function of giant congenital melanocytic nevi in infants and children, and avoid the scar formation due to the adoption of full thickness skin. The key is to ensure the early survival rate of composite skin graft.
ABSTRACT
Objective@#To analyze the vascular distribution of palmar digital arteries in congenital syndactyly through CT angiography and its significance for operation design.@*Methods@#From January 2012 to May 2016, 67 cases with congenital syndactyly were divided into simple, complex and syndrome type(Poland syndrome). Preoperative angiography was performed to reconstruct 3-D distribution of digital arteries.@*Results@#33 cases with 48 pairs simple syndactyly had relatively normal distribution and diameter of digital arteries, but the 7 case with 11 pairs complex syndactyly had only one palmar digital artery in 4 pairs, and two arteries in 4 pairs with decreased arteries diameter. 25 cases with Poland syndrome and 66 pairs of snydactyly had normal distribution of digital arteries with relatively small diameter.@*Conclusions@#Angiography is not necessary for simple type syndactyly, but should be performed in patients with III and IV Poland syndrome and complex type to analyze the vascular distribution within the syndactyly and give help for operative design.
ABSTRACT
Objective@#To explore the methods and the clinical effect of composite skin graft with meshed acellular allogeneic dermal matrix(allo-ADM)and split thickness autogenous skin graft for pediatric claw hand.@*Methods@#From January 2013 to March 2016, acellular allogeneic dermis matrix(allo-ADM)with split thickness autogenous skin graft was applied for 13 cases(20 hands) of burned pediatric claw hands. The size of the wounds ranged from 6cmx6cm to 10cmx17cm, located in the back of the proximal phalanx and hand. The scar was totally excised and hands′deformities were corrected, with allo-ADM and split thickness autogenous skin graft to cover the wounds. Kirschner wire and plaster fixation, graft gauze bag pile were released 2 weeks after surgery, following by wearing a brace and elastic glove for rehabilitative therapy.@*Results@#2 weeks after transplantation the composite skin survival rate was 70%-100%; 10 cases(17 hands) were followed up for 10 months to2 years. The skin graft survival rate was 70% in 2 cases(3 hands), who underwent secondary operation to correct deformity. The composite skin graft survival rate was above 90% in 8 cases(14 hands). Long term follow-up results showed that composite skin graft had satisfactory elasticity and color. According to the active range assessment of joint movement (TAM method), the results were excellent (TAM% equals to 100%) in 4 hands, good (TAM% was greater than 75%) in 11 hands and acceptable (TAM% was equal to 50%) in 2 hands.@*Conclusions@#Composite transplantation of acellular allogeneic dermis matrix with spit thick autogenous skin graft can effectively improve the appearance and function of children′s claw hand, while avoiding the scar formation due to the harvest of full thickness skin.
ABSTRACT
Objective To evaluate the application value of 18 F‐FDG PET/CT in patients with fever of unknown origin (FUO) to improve the etiological diagnosis accuracy of PET/CT in patients with FUO and provide better service for clinical prac‐tice .Methods Clinical data and imaging results of 144 cases of FUO patients diagnosed through 18 F‐FDG PET/CT examination in Wuhan union hospital from December 2009 to December 2011 were retrospectively analyzed .The final diagnoses were based on sur‐gical pathology ,aspiration cytology ,or discharge diagnosis combined with more than 12 months of follow‐up results .All the PET/CT images were analyzed and the clinical application value of PET/CT in FUO patients were evaluated through the diagnose rate , diagnose efficiency and clinical staging of malignant tumor .Results Among the 144 patients ,there were 130 cases ultimately had clear diagnosis ,which including 41 cases of malignant tumor ,89 cases of benign lesions and 14 cases the cause of unknown .PET/CT detected abnormal lesions for 97 .6% (40/41) of patients with malignant lesions and 88 .7% (79/89) of patients with benign le‐sions ,and the diagnostic sensitivity ,specificity ,accuracy ,positive predictive value ,and negative predictive value were :97 .6% (40/41) ,86 .5% (77/89) ,90% (117/130) ,76 .9% (40/52) and 98 .7% (77/78) .PET/CT detected the primary lesions for the first time in 46 .3% (19/41) patients with malignant tumor ,and detected more lesions than the traditional imaging methods in 92 .7% (38/41) of these patients .Conclusion 18 F‐FDG PET/CT imaging can provided important reference value for the detection of primary lesions ,the qualitative diagnosis of benign and malignant lesions and clinical staging of malignant lesions .
ABSTRACT
A total of 60 patients with cognitive impairment were divided randomly into observation and control groups.Both groups were treated by conventional exercise therapy and computer-assisted cognitive rehabilitation while humanities therapy was combined in the observation group.After 8-week treatment,Loewenstein occupational therapy cognitive assessment (LOTCA) and modified Barthel index (MBI) scores were enhanced in both groups (P ＜ 0.05) while the scores of self-rating anxiety scale (SAS)and self-rating depression scale (SDS) declined obviously in observation group (P ＜ 0.05).The thought operation function,optomotor tissue,consciousness,concentration and total score of cognitive function in observation group were higher than control group (P ＜ 0.01) while the scores of SAS and SDS obviously lower (P ＜ 0.01).The scores of SAS were (50 ± 4),(55 ± 5) and SDS (53 ± 4),(56 ± 5) in two groups respectively.Therefore the therapy of computer cognitive rehabilitation plus humanities has the significant effect on improving cognitive function.
ABSTRACT
A total of 60 brain injury patients with cognitive impairment were randomly divided into electro-acupuncture,computer and combination groups (n =20 each).The electro-acupuncture group received electroacupuncture,computer group cognitive rehabilitation training with specialized equipment and combination group both regimens.The treatment lasted for 2 months.Before training,Loewenstein occupational therapy cognitive assessment (LOTCA) test was not statistically significant among all groups (P 8 0.05).After 1 month,the combination group scored higher than pre-training (P ＜ 0.05).After 2 months,the scores of all groups were higher than pre-training(P ＜ 0.05).After 1 and 2-month training,the combination group scored higher than the other two groups in aspects of consciousness,optomotor tissue,attention,thinking and aggregate score (P ＜ 0.05).However,the orientation scores of all groups changed insignificantly after 1-month training (P 8 0.05),the combination group scored higher than the other two groups in improved orientation after 2 months (P ＜ 0.05).
ABSTRACT
Objective To study the effects of community nursing interventions on stroke patients with attention disorders.Methods A total of 60 stroke patients fulfilling eligibility were divided randomly into two groups.Their data were collected between December 2010 and February 2012.The intervention group was treated by community nurses while the control group trained by family members.Attention was assessed by simple reaction time (SRT) and number cancellation test (NCT).Modified Barthel index was used to assess the activities of daily living (ADL).Both groups were evaluated before and after a 2-month intervention.Results Before treatment,the control group had(0.71 ± 0.25),(662.8 ± 152.7) and(31 ±8)scores at SRT,NCT and MBI respectively.And the intervention group yielded(0.69 ± 0.19),(652.7 ±131.0) and (30 ± 8)scores at SRT,NCT and MBI respectively.There were no significant differences in average value of SRT,NCT and MBI between training and control groups at pre-treatment (P ＞ 0.05).After 2 months,the control group had (0.68 ± 0.20),(637.4 ± 151.7) and (33 ± 8) scores at SRT,NCT and MBI respectively.And the intervention group yielded (0.56 ± 0.16),(540.3 ± 125.9) and(37 ± 8) scores at SRT,NCT and MBI respectively.Very significant difference existed in attention scale scores at Month 2 (P ＜ 0.01) and the difference in ADL scale scores was also significant (P ＜ 0.05).Conclusion For stroke patients with attention disorders,strengthening community nursing interventions may help to improve attention and boost activity of daily living.